Methods and devices suitable for improved reattachment of detached cartilage to subchondral bone

Abstract

The methods and devices disclosed herein are effective in the promoting the reattachment of delaminated cartilage to bone. The methods (and related devices) are effective in the removal of the acellular layer of the delaminated cartilage or effective in the indentation of the acellular layer of the delaminated cartilage thereby exposing the underlying chondrocyte cells and thereby allowing the promotion of the reattachment of the delaminated cartilage.

The invention claimed is: 
     
       1. A method for promoting the reattachment of a delaminated cartilage to a bone at a cartilage-bone interface, comprising:
 subjecting an acellular layer comprising avascular tissues at a site of the delaminated cartilage surface to a fluid movement generated by one or more of a positive pressure, a negative pressure or a cavitation or a combination thereof, wherein said fluid movement removes at least a portion of the acellular layer, thereby promoting the reattachment of said delaminated cartilage to said bone; 
 wherein said promoting the reattachment of a delaminated cartilage to a bone at a cartilage bone interface does not involve perforation of subchondral bone to generate a blood clot. 
 
     
     
       2. The method of  claim 1 , wherein said fluid movement is produced by a water jet. 
     
     
       3. The method of  claim 1 , wherein said fluid movement is produced by a suction producing device. 
     
     
       4. The method of  claim 1 , wherein said fluid movement generated by said cavitation comprises contact of a liquid with an ultrasound transducer. 
     
     
       5. The method of  claim 1 , wherein said method further comprises a subchondral disruption of a bone surface. 
     
     
       6. The method of  claim 5 , wherein said subchondral disruption comprises at least partial removal of a calcified cartilage from a bone surface. 
     
     
       7. The method of  claim 6 , wherein said calcified cartilage is removed from about 0.02 mm to about 3.0 mm from the bone surface. 
     
     
       8. The method of  claim 1 , wherein said promoting the reattachment of the delaminated cartilage is controlled by regulating said positive or said negative pressure or both. 
     
     
       9. The method of  claim 1 , wherein said promoting the reattachment of the delaminated cartilage comprises promoting an inflammatory reaction. 
     
     
       10. The method of  claim 1 , wherein said method further comprises administering a biophysically compatible glue or an adhesive agent at an interface between the cartilage and the bone. 
     
     
       11. The method of  claim 10 , wherein said adhesive agent is a fibrin-based adhesive agent. 
     
     
       12. The method of  claim 8 , wherein said promoting the reattachment of the delaminated cartilage comprises removing from about 0.02 mm to about 1.0 mm of the cartilage. 
     
     
       13. The method of  claim 11 , wherein said promoting the reattachment of the delaminated cartilage comprises removing about 0.1 mm of the cartilage. 
     
     
       14. The method of  claim 1 , wherein said method further comprises exposing the acellular layer of the delaminated cartilage to a mechanical exfoliant. 
     
     
       15. The method of  claim 14 , wherein said mechanical exfoliants are granules. 
     
     
       16. The method of  claim 14 , wherein said mechanical exfoliants are selected from the group consisting of sodium tetraborate decahydrate granules, polyethylene silica, calcium carbonate, natural ground seeds, natural ground beans, aluminum oxide, monosaccharides, disaccharides and ice crystals. 
     
     
       17. The method of  claim 1 , wherein said method further comprises exposing the acellular layer of the delaminated cartilage to an exfoliant. 
     
     
       18. The method of  claim 17 , wherein said exfoliant is a chemical exfoliant. 
     
     
       19. The method of  claim 18 , wherein said chemical exfoliant is selected from the group consisting of alpha hydroxyl acid, beta hydroxyl acid, one or more citrus juices and papain.